Nose

The goal

An aesthetic rhinoplasty aims to restore the balance of the face. This of course depends on your personal facial features, which need to be properly analyzed in advance. Every nose operation is different and is adapted to your personal situation. That is the only way to get good results.

The nose plays an important role in the way people perceive you. Your nose must therefore fit in YOUR face. If the nose fits well after the procedure, a weight will be lifted from your shoulders. People often tell me "they should have done it years earlier" and "they finally have the nose they should have had from the start." This leads to more confidence and a more open attitude, which has a positive effect on all aspects of life.

What happens during a nose operation?

Technically, an improvement in the shape of the nose can only be achieved by adjusting the structures underneath the skin, such as the bones and cartilage. For this small incisions are made, that - in case of the preservation rhinoplasty technique - reside invisibly, on the inside the nostrils. Adjusting the bones can lead to bruising, although with the use of the Piezo osteotome this bruising is clearly less than normal.

The nose basically consists of 5 parts (the bones, the nasal valves, the nasal tip, the septum and the mucosa lining it all) that are all closely connected. Form and function go hand in hand. If a part has to be adjusted, it is actually impossible to do this without at least taking the rest into consideration. Sometimes cartilage transplantation is needed to achieve the correct shape or firmness.

A nose correction can be a very technically challenging procedure. It must therefore be performed by a plastic surgeon who specializes in this area, so that the chances are as high as possible that expectations can actually be fulfilled. From experience I know that a well performed nose correction can make someone really happy.

What is the "preservation rhinoplasty" technique?

There are several ways to correct a nose. Because I strongly believe in restoring the natural balance with as little "disturbance" of the functional anatomy as possible, I use the so-called "preservation rhinoplasty" technique. With this technique the structures of the nose are respected as much as possible and the scars are invisible as they are only made on the inside of the nose. The operation is much less invasive as the classic and more widespread open rhinoplasty, and the recovery is significantly faster. It is not unusual for someone to be presentable again after one week.

What is the ultrasonic Piezo osteotome?

Rhinoplasty is often a so called reduction procedure, meaning that the nose is reduced in size by taking bone and cartilage away. Since the beginning of rhinoplasty this is done with the use of instruments like chisels and saws. There is however a much less drastic method available to achieve the same. I have gained a lot of experience with this so called ultrasonic Piezo osteotome. This very modern instrument makes it possible to correct the nose with much more control and accuracy. As a result, my customers have much less swelling and bruises than before, which means they can return to normal life more quickly than with other older techniques.

Does perfection exist?

It is important to realize that on average the negative feelings you have about your nose are not shared by the people around you. Frequently, they won’t even see what bothers you or do not understand why you have that wish. That makes sense, because the people you know have long since accepted you, which includes your nose. This is because people do not actually inspect every detail when looking at others, as they more so sense someone’s general appearance or mood. They look at the total picture. It is therefore important to realise that you should never do a nose correction for anybody else but yourself, as experience shows that after the procedure people around you will not see that your nose has changed.

How much you think about your nose (or your appearance) can really hold you back. If you are looking for perfection, any result will disappoint you: perfection simply does not exist. It is normal for a human face to show slight asymmetry (at least the non-photoshopped people among us). Of course I will strive for the best possible result for you, but you should not expect that your nose will be perfect. On the other hand in real life people often like it even better after surgery than expected, because it is such a huge relief and a feeling of liberation as if a weight has been lifted off your shoulders. However, if you are looking for perfection, you should not have a nose operation. A realistic expectation is that your nose will visibly improve as a result of the operation and that you will get a nose that suits you better.

All the steps of a nose correction

All the phases of a typical nose correction are explained below in more detail. My recommendation would be that you read this information carefully and contact us if any questions arise. I wish you a good recovery!

The preparation

• You should not take medication that makes your blood thinner, this increases the risk of bleeding. Therefore, non-steroidal anti-inflammatory drugs such as aspirin, Brufen, Ibuprofen and Nurofen should be stopped two weeks before surgery, up until to two weeks after the procedure.
• Ask us in advance if you have any doubts about the safety of your current medication regarding the operation.
• If you smoke, it is strongly recommended that you quit two weeks before to at least a week after the surgery. Smoking restricts blood flow and irritates the nasal mucosa, which may prevent proper wound healing.
• Make sure someone is able to pick you up after your surgery, because you can't drive home (besides the fact that you won’t be insured) if you’ve just undergone surgery.
• We advise you to shop for your groceries in advance, so that you don’t have to do this immediately after the operation.
• We also advise you to arrange for some help at home for the first few days after surgery.
• Please make sure to get the prescribed medications at home before the date of surgery. You should start the Bactroban nasal ointment one week before the operation, so that the bacteria that is already naturally present in your nose.

The operation

• Please come to the surgery without any jewelry, makeup or contact lenses in.
• On the day of the operation, I’ll see you right before the operation and I will briefly go through the procedure with you again.
• Before the surgery I will take pictures to record the original situation.
• The operation will be performed in a fully equipped operating room, adhering to the strictest medical rules and guidelines.
• The operation is performed under general anesthesia, which is always well tolerated. Before we start, we’ll do a final safety check. After that you will receive a sleeping aid through an IV and fall asleep calmly.
• Typically the operation is performed through incision on the inside of the nose. These cuts are not visible on the outside and they won’t be very painful or annoying. Occasionally it is necessary to make an incision on the underside of the skin bridge in between your nostrils in order to get a better correction of the cartilages of the nose tip. The disadvantage of this is that it takes a few months for feeling to return in the nose tip and the incision to fade.
• The operation takes one and a half to two hours.
• At the end of the procedure, a customized thermoplastic splint is placed on the bridge of the nose, which should be left in place for a week.
• If the nasal septum has also been corrected, two splints are also left in the nose for support. These splints contain tubes that allow you to breathe - albeit slightly less than usual. I don’t use any tampons. I don’t use any tampons in the nose.

After the procedure

• After the operation you will be taken to our recovery room. Your face will be cooled there to prevent the swelling as much as possible.
• Once the local anaesthetic has worn off (after 2-4 hours), you may experience some discomfort for a few hours. Paracetamol (2x500mg) is usually sufficient.
• A nose correction typically isn’t a painful operation. It can happen that people are somewhat limited by the swelling or experience a pressing feeling. In the unlikely event that the area still feels unpleasant, you can use the painkillers that you have already received on prescription as a precaution from us.
• In the beginning, the operating area slowly swells and (sometimes) some bruises arise. The swelling will increase for two to three days before it subsides.
• Avoid bending or lifting heavy things in the first few days. During this period perhaps it could be pleasant to sleep with an extra pillow so that your head is slightly higher, then the swelling will decrease faster.
• You’ll notice that you can do many things in your daily life, you are simply limited by the healing process. You will have to adjust your pace accordingly. If you don’t do this, the process will be more troubling than is necessary.
• We’ll make an appointment for a week after the operation. The cast and any splints are removed. From this moment onwards using make-up is possible again.
• By this time the swelling and bruising, if any, have usually returned to an acceptable level that allows social activities to resume. Sometimes, however, these side effects take longer to disappear completely. We therefore recommend that you do not plan very important social activities in the first 3 weeks after the procedure.
• We also recommend that you avoid any heavy physical activities in the first 2 weeks.
• It is common for the nose, especially the tip of the nose, to feel numb in the first weeks after the procedure. This is completely normal and will disappear on its own. For the tip of the nose, as the lowest part of the nose, this will take the longest, sometimes even longer than half a year.
• It will take a full year before the nose is completely healed, all the swelling is gone and you feel that you have your own nose back.
• Regular check-ups are at 1 week, 3 months and 1 year after the procedure. In the meantime, of course you are welcome if there are any questions or concerns.

And another matter

A nose surgery is a very complex operation, the result of which cannot be predicted a 100%. By far most of the things people worry about in the beginning disappear in the course of the healing. In the very few cases where it does not go away by itself, it will be necessary to have a second intervention to correct these unwanted imperfections. It is however important to realize there is a limit to what is possible. I will discuss that with you if that situation arises. If it comes to a post-correction, it usually involves a minor intervention (which principally will be free of charge, depending on the cause of the problem). The condition is that you come to the final inspection 1 year after the operation to evaluate and discuss this.